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Home , Abdominal pregnancy, Ectopic pregnancy

Ectopic can be a very distressing and frightening experience. This leaflet aims to explain what ectopic pregnancy is, to provide you with information and to answer some of the most common questions about both facts and feelings. We hope this will help at what can be a very difficult time.

What is an ectopic In rare cases (3 to 5% of ectopic pregnancy? ) the pregnancy implants somewhere other than the tube. A An ectopic pregnancy is one that non-tubal ectopic pregnancy might be: develops outside of the womb (the word “ectopic” means “out of place”). • an interstitial ectopic : the Between 1 and 2 in 100 pregnancies in pregnancy implants in the top the UK are ectopic and for some corner of the near the women, this can be a life-threatening condition. • a cervical ectopic : the pregnancy implants in the (the neck of Usually in pregnancy, a sperm and an the womb) egg meet in one of the two tubes (the Fallopian tubes) that connect the • a ectopic : the pregnancy to the womb (uterus). The implants in the scar from a previous fertilised egg then moves down the tube by being wafted by fine hairs • a cornual ectopic: the pregnancy inside the tubes until it reaches the implants in a corner of the uterus womb two or three days later. Once which itself has not formed there, it implants, attaching itself to the normally womb lining and that is where it • a : a usually continues to grow and develop. pregnancy where one is in the In an ectopic pregnancy however, a correct place but one is ectopic fertilised egg implants outside of the • an ovarian ectopic : the pregnancy womb, usually in one of the Fallopian implants in an tubes. This is called a tubal ectopic • an : the or tubal pregnancy . pregnancy implants somewhere A tubal pregnancy cannot lead to the within the of a baby. The Fallopian tube These are all rare conditions with cannot expand as the womb does to individualised treatment. make room for a developing embryo and it does not have a sufficient This leaflet focuses mainly supply. There is currently no way of on tubal ectopic pregnancy, transferring the early pregnancy safely though some information to the womb. might still be relevant for non-tubal ectopics.

2 Why does it happen? • abdominal , such as having We don’t always know why an ectopic your appendix out, a Caesarean pregnancy has occurred, but there are section, or surgery for an ectopic some known causes and risk factors. pregnancy • , a condition which As we’ve said earlier, a fertilised egg can damage the Fallopian tubes normally takes two or three days to travel down the Fallopian tube to the • some fertility problems. Even an womb. It implants there between six IVF pregnancy can be ectopic. and seven days after . • some forms of contraception, such With an ectopic pregnancy, however, as the -only pill the fertilised egg’s journey is slowed • cigarette : smokers tend to down and it implants itself before it have an increased level of a protein reaches the womb. There are several in their Fallopian tubes that can things that can make it more difficult slow the progress of the fertilised for the egg to pass through the tube, egg. including damage to the tiny hairs that waft it towards the womb. The causes It is sometimes thought that having an include: IUCD (intra-uterine contraceptive device, or coil) increases the risk of • a previous ectopic pregnancy ectopic pregnancy. That’s not really the • in the uterus, Fallopian case. It’s more that the IUCD is good tubes or ovaries, especially if they at stopping a pregnancy implanting in develop into pelvic inflammatory the uterus, but can’t prevent it disease (PID). is one implanting in the tube or elsewhere. example. There is also a higher risk of ectopic • surgery on the Fallopian tubes, pregnancy amongst women over the perhaps for a previous ectopic age of 35. pregnancy or for sterilisation

(or to reverse sterilisation) Many women who have an ectopic

pregnancy, however, have no known risk factors. The scan showed that the baby was in“ the tube instead of the womb. I asked if it could be moved “ but was told it was impossible.

3 What happens when a There is a tubal pregnancy is ectopic? The pregnancy cannot continue growing in the tube and is miscarried Not every case of ectopic pregnancy is naturally. The Fallopian tube contracts the same. It can be that: (squeezes and releases) to push the The pregnancy stops pregnancy out from the tube into the developing and is gradually abdomen. Your body can then gradually reabsorbed back into the body, as in absorb the pregnancy tissue, but an an early miscarriage. If the ectopic scan may show blood or pregnancy resolves (ends) naturally, fluid in your pelvis. You may need then no further treatment is needed. further tests and perhaps treatment. The pregnancy continues to Your doctor may not be able to tell grow whether this was an ectopic pregnancy , stretching the thin wall of the or a very early miscarriage. If so, it tube. If untreated, the tube may may be called a pregnancy of unknown rupture (burst or tear open) and this location (PUL). needs to be dealt with urgently. Non-tubal ectopic pregnancies may continue to grow for longer as they may have more room to do so. They rarely resolve without treatment, which is usually surgical. They can also be more difficult to diagnose so more tests may be needed.

ectopic pregnancy (pregnancy growing in the wrong place) fallopian tubes

ovary ovary

uterus (womb) (where the pregnancy should grow)

4 What are the symptoms of an ectopic pregnancy? I had a feeling something wasn’t You may have had one or more of the

“ quite right with symptoms listed below, probably

the pregnancy and between the fifth and tenth week of at six and a half your pregnancy – but sometimes there “ weeks I doubled are no obvious symptoms. This can up in excruciating make ectopic pregnancy very difficult pain. to diagnose, especially if you do not know or even suspect that you are pregnant.

Symptoms can include: • Collapse You may feel lightheaded, dizzy and/ • Irregular vaginal or faint. You may also have a feeling Bleeding that is different from your that something is very wrong. normal period. It may be constant You might look very pale, have a but light over a number of weeks racing pulse and feel sick. or you may have a brown discharge or spotting. Occasionally some • No symptoms women think they may have had a You may have no symptoms at all. light period and then they start bleeding again 10-14 days later and If you are or could do not realise that they are possibly be pregnant now pregnant. and you have: • Pain low in your abdomen , • and/or perhaps just on one side. It might start suddenly or develop gradually • shoulder-tip pain and/or and it can be constant and severe. • feel dizzy or faint and/or • Shoulder-tip pain • diarrhoea, pain on passing Pain where your shoulder meets urine or opening your bowels your arm. This happens if there is into your – you should seek medical advice immediately abdomen. , even if you are using contraception and don’t • Bowel or bladder problems think you could become pregnant. You may have diarrhoea and perhaps ; or pain when If you have any of the other opening your bowels or passing symptoms listed on this page and urine. your is positive, you should speak to your doctor or midwife within 24 hours.

5 How is an ectopic • Blood tests pregnancy diagnosed? These are to measure levels of the pregnancy hormone ßhCG in your Ectopic pregnancy can be very difficult blood. In early pregnancy, the levels to diagnose. The symptoms can be should double roughly every 48 hours. mistaken for gastro-enteritis, irritable After a miscarriage, they drop quite bowel syndrome, miscarriage or even quickly. If they rise slowly, or stay around . the same level over this time, this can In hospital, unless you are extremely mean a pregnancy is failing or an ectopic unwell, the first steps are usually: pregnancy. Some units also measure the level of the hormone progesterone in • A medical history the blood. This can sometimes help to You will be asked about your show if the pregnancy is failing or symptoms, pregnancy history and growing without having to repeat the your previous medical history hCG after 48 hours.

• A pregnancy test Blood tests alone cannot tell where (urine and/or blood) the pregnancy is developing, but they can help doctors monitor patients • An ultrasound scan who might have a growing ectopic You are most likely to have a pregnancy. transvaginal (internal) scan, as this provides the clearest picture in early • pregnancy. It will not damage your This investigation is done under pregnancy. The scan could show: general anaesthetic. A tiny camera is • A pregnancy that is developing passed through a small cut in your normally in the womb. You probably abdomen so that your Fallopian tubes won’t need further treatment and internal organs can be seen unless your symptoms continue or directly. If it is clear that there is a get worse. tubal pregnancy, it will usually be removed at the same time. • A pregnancy that seems to be failing or has died. You will probably be offered an appointment for I did not have any another scan or options for treating of the typical a miscarriage “ symptoms and only minimal pain • An empty womb. This finding is

but had I not called a pregnancy of unknown

pushed for blood location (PUL) and you will need tests, there is little further tests. “ doubt that the • A pregnancy developing outside the ectopic would have womb – an ectopic pregnancy. This ruptured. often can’t be seen in the first weeks of pregnancy, but might be seen later. 6 How is a tubal ectopic pregnancy managed I was given plenty (treated)? of information

“ throughout the

If you are very unwell, the only safe process but I think option may be an urgent operation to this was because confirm the diagnosis and to stop as an ex-nurse, I “ internal bleeding. knew and was not In most cases, though, there may be afraid to ask. several options, depending on your condition, the scan report and any additional blood tests, and you should • your ßhCG levels are relatively low have time to discuss these with your and doctor. We describe these treatments over the next few pages. • during monitoring these levels continue to fall. Conservative or expectant management If you do have conservative management, you will need repeated This is sometimes described as visits to hospital to have your “watchful waiting”. It means that you pregnancy hormone levels checked. don’t have any active treatment, but Until your results are back to normal, are checked regularly to make sure there is still a risk that your tube that the ectopic pregnancy is ending might rupture. naturally. During this time it is important to You might be offered this treatment if: think of who you would contact in an • you are well (you have a normal emergency for support if you became pulse and blood pressure and little unwell. It is also important not to have or no pain) sexual intercourse as this can increase the risk of rupture, and to avoid • there is no sign on the ultrasound alcohol as this it may complicate the scan that the tube has ruptured situation if you become unwell.

7 Medical management The drug that is most often used is Sometimes an ectopic pregnancy can and it is usually injected be treated with drugs that stop the into a muscle. Methotrexate is a drug development of the pregnancy and that is used for many conditions to allow it to be re-absorbed by the body. stop the growth of rapidly dividing This may be offered if: cells. It can cause abnormalities in a developing baby so it can only be given • you are well (you have a normal when the diagnosis of ectopic pulse and blood pressure and little pregnancy is certain. or no pain) Medical management isn’t suitable for • there is no sign on the ultrasound everyone, and especially not if: scan that the tube has ruptured • your pregnancy hormone levels are • you have a small ectopic pregnancy very high with no heartbeat • you have other medical problems • your ßhCG levels are relatively low that mean you should not use methotrexate (for example, kidney failure)

I was able to have methotrexate

as the ectopic was caught quite

“ early. The injection was fine and I had no side-effects, but I needed two lots of treatment “ and repeated blood tests before the pregnancy was over.

8 The advantage of medical management Some women have mild side-effects is that if it is successful (which it is in from the treatment, such as mouth 90% of cases), you avoid having an ulcers, abdominal pain, or skin operation and probably won’t need to rashes. You are also more at risk of stay in hospital. If it is unsuccessful, you sunburn and a small amount of hair may still need to have an operation. loss.

After the injection you will need If you have medical treatment, you will regular blood tests to measure your be advised to wait three months hormone levels and check that they before trying for another pregnancy. are falling. This is because the drug can be harmful to an early pregnancy by The blood tests are usually done at reducing the amount of folic acid in the start of treatment, days 4 and 7 your system. after treatment; then weekly after that until they are normal. This can take 4 It is important to make sure the drug to 6 weeks, depending on the level at is out of your system before you get the beginning. pregnant again.

About 15% of women will need a Once your hormone levels are back to second injection and a smaller number normal, it is also advisable to restart may need surgery. your folic acid if you plan to try again.

Until your hormone levels are back to normal, it is important not to have sexual intercourse as this can increase the risk of rupture, and to avoid alcohol as this it may complicate the situation if you become unwell. I’m glad I avoided surger“ y but the treatment made me very sick and I was absolutely exhausted for “ about two weeks.

9 Surgical management Laparoscopic (key-hole) surgery (under general anaesthetic). shortens the length of time you need to stay in hospital and you will recover This is the recommended treatment if: physically more quickly than after open • you are acutely unwell, with severe surgery. pain or internal bleeding But this might not be possible, • there is a live ectopic pregnancy because, for example: • your hormone level is very high • you are too unwell or • the diagnosis is uncertain • you have had previous abdominal surgery or The advantage of surgical management is that it is a relatively quick treatment • you are very overweight or that does not usually require repeated • the doctor operating is more skilled hospital visits and blood tests. It may and experienced at performing also be the treatment that you prefer open rather than key-hole surgery. when you compare it with the other options. However, it is not usually In this case, you will have an operation offered if your hormone levels are which leaves a scar along the pubic very low unless there are other hair line (bikini line). medical reasons to do so. In either operation, the doctor looks In most hospitals, the operation is done carefully at the Fallopian tubes and by laparoscopy (key-hole surgery). This other pelvic organs. This might give an involves making two or three small cuts idea of what caused the ectopic to the abdomen so that a camera can pregnancy, though this isn’t always directly show the ectopic pregnancy clear. It might also help your doctor and allow access for the instruments to advise you about a future pregnancy. be used to remove it.

I was very unwell and in a lot of pain. I was rushed into theatre where they found I had an ectopic “ “ pregnancy which had ruptured. I’m slowly recovering but it’s been incredibly difficult.

10 If this is your first ectopic pregnancy, Sadly for some women a further your doctor will advise removing the ectopic pregnancy will result in the affected tube completely, with the loss of both Fallopian tubes. This can pregnancy tissue inside. This is called a have a huge emotional impact and the . only option for a future pregnancy would be through IVF ( in vitro If you have damaged tubes, however, fertilisation). or had a previous ectopic – and especially if you have already had one For further information, advice and tube removed – there might be support on the availability of this another option. It might be possible to treatment it is best to see your GP. remove the ectopic pregnancy from the remaining tube, and leave the tube behind. This is called a salpingotomy .

The advantage of this second option is that you will still have at least one It was like a double loss. I lost my baby tube left. The disadvantages are that: “ “ and I lost one of my • it increases the risk that not all the tubes. It felt like the pregnancy tissue is removed, and end of the world. • you will need additional follow-up to check your hormone levels, and • there is a higher risk of a future tubal pregnancy.

11 How is a non-tubal After the treatment ectopic pregnancy If you have surgical management, any managed? tissue removed will be examined The management of non-tubal under the microscope to confirm that pregnancies depends on where the it was an ectopic pregnancy. That pregnancy has implanted and whether tissue is usually then disposed of by or not it is still alive. Each case needs the hospital, in accordance with their to be considered separately, but most sensitive disposal policy. If you prefer are managed surgically . to take the remains of your pregnancy home to bury or to make your own For further information on the arrangements, you can ask for them to management of non-tubal ectopic be returned to you. pregnancy, it might be useful to visit the website of the Royal College of Obstetricians and Gynaecologists How long does it take to (www.rcog.org.uk) which is developing recover? new guidelines on this topic. Recovering from an ectopic pregnancy is different for everyone. You might also find that you recover physically quite quickly, but that your feelings about what has happened stay with you for longer.

12 Physical recovery: After medical management your body You will need to wait for the results of When can I go back to work your blood test on day 7 after or my usual routine? treatment. If the results show that the hormone level is falling and the Once you are home from hospital, pregnancy is resolving, you can start to you’ll probably need to take things return to your normal routine. easy for at least a few days, whatever treatment you have had. If possible, it You may still have bleeding for some is best to return to work only when time, and it is best to wear pads rather you feel ready both physically and than tampons to reduce the risk of emotionally. Your GP will be able to infection. provide you with a certificate (a “fit note”) for work. Your period will not start until at least 4 weeks after your hormones have After surgical management reached very low levels.

After key-hole surgery, you should When is it OK to start recover physically after about two having sex again? weeks. If you have open surgery it is likely to be up to six weeks. This very much depends on how you are feeling after the ectopic pregnancy You should get a period about 4 to 6 and what treatment you have had. weeks after your treatment, but this can take longer, particularly if your After surgery, it is safe to have sexual usual cycle is longer than 4 weeks. intercourse once any bleeding and discharge have stopped. After conservative and medical management it is advisable to wait until your levels are returning to normal. The surgery was

the easy part You may want to wait longer, though,

“ and I recovered especially if you are feeling very tired quickly. It was and/or you are still sore or in pain. You the emotional “ might also be worried about the recovery that possibility of getting pregnant again was hardest. (see page 17).

13 Emotional recovery: You may have felt – or you might still your feelings feel – one or more of the following: Are my feelings normal? Everyone is different, but many women Perhaps you didn’t know you were say that ectopic pregnancy is a very pregnant until your ectopic was upsetting and frightening experience, diagnosed. You had to cope with even if they weren’t planning to have a finding out you were pregnant and baby. that it couldn’t survive all at the same time. There is no right or wrong way to feel and you’ll probably find that you have You might have been treated as an lots of ups and downs in the days, emergency, with everything happening weeks and months after your loss. very quickly. You might have been very frightened, especially if you knew your

I felt nothing at all life was at risk. You may still be at first. The reality replaying those feelings of shock and “ of the situation “ fear in your mind. took several days Perhaps you are shocked by thoughts to hit me. about what might have happened – such as “What if I hadn’t been diagnosed in time?” . This can be true for your partner too.

You may feel very anxious – about what happened or about all sorts of things. And you may have difficulty sleeping. If this becomes a real problem for you, then it is probably a good idea to talk to your GP.

Everything happened so quickly

I never had time to think about

“ it until after my operation. Once I was discharged from hospital I was left feeling very “ alone with so many ‘what ifs’ running through my head.

14 Loss and grief You may feel very sad for the loss of I’m glad I kept the your baby, and for the hopes and tube but in some dreams you had for her or him. Those “ ways I feel the feelings might be very strong and last treatment made longer than you expect. the process longer.

I think I felt there It can be very difficult, especially if was always a tiny other people don’t understand that. hope that the “ You may find it helps to talk to other pregnancy was still people who have had an ectopic viable. pregnancy (see page 19).

Feeling “in limbo” Guilt and blame If you have been treated with methotrexate or are waiting for the You might wonder whether you are ectopic to resolve naturally, you may somehow to blame for what has feel in a kind of “limbo” for several happened. This may be especially true weeks. if you find that you have or had an infection, such as chlamydia. It can be very upsetting to have to go back to the hospital for repeated It is important to know that blood tests until your hormone levels like chlamydia are easily transmitted are back to normal. and often have no symptoms, so can stay hidden for many years. They are If you have been advised to wait some also easy to treat. months before trying again, you might feel that it is even harder to recover You may feel angry with some of the and to begin to move forward. health professionals who treated you. Sadly, ectopic pregnancy can be very difficult to diagnose with certainty but

you may still feel that you might have

Everyone tells me been spared some of what you went how lucky I am to be through if you’d had better care. “ alive. But I’ve lost “ my baby and I just You might want to talk this through feel so empty. with someone whom you feel you can trust (see page 19).

15 Your partner Anxiety about the future The experience of ectopic pregnancy You may worry about whether you’ll can put a real strain on a relationship. be able to get pregnant again. Or you It might bring you and your partner might be frightened that if you do closer together but you might find become pregnant, you might have that he or she doesn’t seem to another ectopic pregnancy. You may understand how you feel and doesn’t wonder whether you should try again, react in the way you want or expect. or whether you even want to.

You may feel differently about what We provide some information about has happened. Your partner may focus this on the next page. It may also be on your health, especially if s/he saw helpful to discuss your questions and you in pain and distress and perhaps concerns with your doctor. felt powerless to help. If you had surgery for the ectopic Partners sometimes think they need pregnancy, your doctor should be able to be strong and supportive, rather to tell you about the condition of your than show any feelings of loss or womb, tube(s) and ovaries and how sadness. this might affect your future fertility – particularly if there is any obvious It may just be that you deal with things damage to the other tube. or express yourselves differently and this can lead to misunderstandings, If you had problems getting pregnant anger and hurt, especially at a this time, you may want to ask if you vulnerable time. can see a specialist before trying again.

You or your partners may find it Getting support helpful to read our leaflet Partners Too . Many women who have had an ectopic It may be that you do not have a pregnancy – and their partners too – partner, and feel very alone. You might find that it can help to talk to need extra support at this time. someone who understands what they are going through. This may be a friend or relative, or perhaps a bereavement nurse, midwife or counsellor. Vicki was terribly upset and having You may prefer to talk to someone “ a lot of pain too. you don’t know personally, perhaps by

I wanted to rescue phone or by using an Internet support

her or take away forum. See page 19 for some the pain, and I suggestions. couldn’t do a d“ amn thing except watch her cry.

16 Thinking about the • there is an increased risk of future another ectopic pregnancy if you do become pregnant. What about future pregnancies? The chance of having another non- tubal ectopic pregnancy The chances of having a healthy is very pregnancy are still good after low, but if it was a cornual pregnancy treatment for an ectopic, even if your and this was managed surgically, there tube is removed. may be other concerns in the next pregnancy. It is important to discuss You will ovulate (release an egg) as this with your doctor at your follow- before, probably once a month. And up appointment. even if you have just one Fallopian tube, it’s possible to get pregnant even When is it best to try for when you ovulate on the opposite side. another pregnancy? This will depend on the type of Overall about two thirds (64%) of ectopic pregnancy you have and the women will get pregnant again treatment you receive. naturally, while some will need help to do so (e.g. fertility treatment) and If you have had surgical treatment, others will decide not to try again. your doctor will probably advise you to wait until you have had at least one What are the chances that period before trying again. After I’ll have another ectopic medical treatment, you will be advised pregnancy? to wait at least three months. The overall chance of you having another ectopic is between 7% and You might want to get pregnant again 10% – so at most, 1 in 10. This will as soon as possible or you may find depend on the kind of treatment that the thought of another pregnancy very you had and the health of your frightening. You and your partner are remaining tube or tubes. the best judges of when – or whether – to try again. If you had surgical treatment but the tube was not removed (salpingotomy), the risk of another ectopic is slightly The next time higher, at around 15%. I fell pregnant

“ I was full of fear, When one Fallopian tube is damaged

but an early scan (because of infection or scarring, for reassured me, example), there is a higher chance than “ showing the baby normal that the other tube may be safely in the damaged too. This means that: womb. • the chance of getting pregnant is less than normal

17 What about contraception? It is also essential to talk to your If you don’t want to get pregnant, you doctor if you might be pregnant and may want to talk to your doctor or have any symptoms that might mean family planning clinic about what kind another ectopic: a late period, bleeding of contraception is best for you and that is different from usual or any of what to avoid. After an ectopic the other symptoms listed on page 5. pregnancy an IUCD (coil) is not If you are pregnant and an early scan recommended; and some types of shows a developing pregnancy in the progesterone-only contraception can womb, then you are unlikely to need increase the chance of having another any further special care or tests. You’ll ectopic. be booked in for routine scans at Will I need special care in my around 12 and 20 weeks. next pregnancy? The most important thing in your next Finally: pregnancy is to find out early if it is developing in the right place. So once The experience of ectopic pregnancy you have a positive pregnancy test, it is can be extremely distressing. You may best to consult your GP so that he or feel very relieved to be alive and free she can arrange for an ultrasound scan of pain, yet still feel deeply sad at the at around six to seven weeks. loss of your baby and anxious about the future. It is not usually helpful to have a scan before six weeks as it can be too early Whatever your feelings and anxieties, to confirm where the pregnancy is you don’t have to bear them alone. We developing. However, if you have pain hope that reading this leaflet has been or bleeding, it is best to go to your of some help and that you can use local Early Pregnancy Assessment Unit some of the resources opposite to for assessment even if it is before six help on your journey to recovery. weeks.

If you see a GP or hospital doctor who doesn’t know your history, it is Just talking to

important to tell them about your people that

ectopic pregnancy so they understand “ understand what that an early scan is important. It is I’ve been through helpful to tell them or the person and how I’m feeling “ scanning you which Fallopian tube was makes me feel like affected and/or removed. I’m not alone.

18 Information and Useful reading support NICE clinical guideline (CG154) The Miscarriage Association Ectopic pregnancy and miscarriage: has a telephone helpline, a volunteer Diagnosis and initial management in early support service, an online support pregnancy of ectopic pregnancy and forum and a range of helpful leaflets miscarriage. on pregnancy loss. National Institute for Health and Care Helpline: 01924 200799 Excellence, December 2012. www.miscarriageassociation.org.uk http://www.nice.org.uk/guidance/CG154 17 Wentworth Terrace, Wakefield Books: WF1 3QW Small Sparks of Life , by Lysanne Sizoo Ectopic Pregnancy Trust Gopher Publishers, 2001; ISBN 90-76953-26-0 provides information and support on ectopic pregnancy. Hidden Loss: Miscarriage and Ectopic Helpline: 020 7733 2653 Pregnancy , edited by V. Hey, C. Itzin, www.ectopic.org.uk L. Saunders and M.A. Speakman Women’s Press 1995, 1996; For advice on symptoms, it is best to ISBN 0-7043-44572 call your GP, out-of-hours service or Other leaflets from the the NHS 111 helpline (0845 4647 in Miscarriage Association: Wales). Partners Too If you suspect an ectopic pregnancy, Pregnancy loss and seek help immediately from your GP, When the trying stops your nearest Early Pregnancy Unit, or Accident & Emergency Department. Thanks For a list of Early Pregnancy Units: Our sincere thanks to Dr Jayne www.earlypregnancy.org.uk Shillito, Consultant Obstetrician and (Association of Early Pregnancy Units) Gynaecologist, Leeds Teaching Hospitals NHS Trust, and to Ms Jackie Ross, Consultant Gynaecologist, King’s College Hospital, London, for their help in writing this leaflet; and to everyone who shared their thoughts and experiences with us.

Need to talk to someone who understands? Call our support line on 01924 200799. Monday to Friday, 9am-4pm Or email [email protected]

19 The Miscarriage Association 17 Wentworth Terrace Wakefield WF1 3QW Telephone: 01924 200799 e-mail: [email protected] www.miscarriageassociation.org.uk

© The Miscarriage Association 2014 Registered Charity Number 1076829 (England & Wales) SC039790 (Scotland) A company limited by guarantee, number 3779123 Registered in England and Wales

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